Healthcare Provider Details

I. General information

NPI: 1659252401
Provider Name (Legal Business Name): SHARI JAN FERNEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 W 500 N
LOGAN UT
84321-3711
US

IV. Provider business mailing address

435 W 500 N
LOGAN UT
84321-3711
US

V. Phone/Fax

Practice location:
  • Phone: 503-858-0740
  • Fax:
Mailing address:
  • Phone: 503-858-0740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number262756-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number262756-8900
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: